术前诊断为胰腺癌术中细针穿刺细胞学检查阴性结果病例分析

目的 探讨术前诊断为胰腺癌术中细针穿刺细胞学（FNAC）检查阴性结果病例的临床意义和提高诊断准确性的方法。方法 回顾性分析1995年12月至2006年6月中国协和医科大学肿瘤医院术前诊断为胰腺癌，术中FNAC结果阴性的33例病人的临床特点、影像表现、实验室检查结果和随访资料。结果33例均获得随访，时间3个月至8年，其中30例为真阴性病例，肿物为慢性肿决型胰腺炎所致；3例为假阴性病例，术后出现肿决增大，肿瘤多发转移。结论慢性胰腺炎（CP）是出现阴性结果的主要因素，肿瘤体积大小、生长方式和术者取材技术决定FNAC的准确性。应提高对慢性胰腺炎临床特点的认识及术前诊断的准确性，改进穿刺取材和制片技术可以降低假阴性率。

Reason for negative result in intraoperative fine needle aspiration cytology for preoperative diagnosis as pancreatic cancer

Objective To investigate the meaning of negative result in intraoperative fine needle aspiration cytology (FNAC) of pancreas spaceoccupy lesion and the pattern to increase the accuracy.Methods The clinical data of 33 patients with negative FNAC findings diagnosed as pancreatic cancer preoperatively between December 1995 and June 2006 were analyzed retrospectively.The clinical data included the clinical character,image feature,laboratory examination result and clinical follow-up.Results All the patients were followed up for 3 months to 8 yeas.Among them,30 cases were diagnosed as chronic pancreatitis (CP) because the lesions unchanged with true negative label.Three cases were found tumor extend and multi-metastases with false negative label.Conclusion Chronic pancreatitis (CP) is main reason for the negative result.Tumor volume,growth pattern and technique of operator affect the result of FNAC.Acknowledging the clinical character of CP,reversal aspiration at malignant suspect lesion,improving aspiration technique will reduce false negative cases.